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Liu XZ, Duan M, Huang HD, Zhang Y, Xiang TY, Niu WC, Zhou B, Wang HL, Zhang TT. Predicting diabetic kidney disease for type 2 diabetes mellitus by machine learning in the real world: a multicenter retrospective study. Front Endocrinol (Lausanne) 2023; 14:1184190. [PMID: 37469989 PMCID: PMC10352831 DOI: 10.3389/fendo.2023.1184190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
Objective Diabetic kidney disease (DKD) has been reported as a main microvascular complication of diabetes mellitus. Although renal biopsy is capable of distinguishing DKD from Non Diabetic kidney disease(NDKD), no gold standard has been validated to assess the development of DKD.This study aimed to build an auxiliary diagnosis model for type 2 Diabetic kidney disease (T2DKD) based on machine learning algorithms. Methods Clinical data on 3624 individuals with type 2 diabetes (T2DM) was gathered from January 1, 2019 to December 31, 2019 using a multi-center retrospective database. The data fell into a training set and a validation set at random at a ratio of 8:2. To identify critical clinical variables, the absolute shrinkage and selection operator with the lowest number was employed. Fifteen machine learning models were built to support the diagnosis of T2DKD, and the optimal model was selected in accordance with the area under the receiver operating characteristic curve (AUC) and accuracy. The model was improved with the use of Bayesian Optimization methods. The Shapley Additive explanations (SHAP) approach was used to illustrate prediction findings. Results DKD was diagnosed in 1856 (51.2 percent) of the 3624 individuals within the final cohort. As revealed by the SHAP findings, the Categorical Boosting (CatBoost) model achieved the optimal performance 1in the prediction of the risk of T2DKD, with an AUC of 0.86 based on the top 38 characteristics. The SHAP findings suggested that a simplified CatBoost model with an AUC of 0.84 was built in accordance with the top 12 characteristics. The more basic model features consisted of systolic blood pressure (SBP), creatinine (CREA), length of stay (LOS), thrombin time (TT), Age, prothrombin time (PT), platelet large cell ratio (P-LCR), albumin (ALB), glucose (GLU), fibrinogen (FIB-C), red blood cell distribution width-standard deviation (RDW-SD), as well as hemoglobin A1C(HbA1C). Conclusion A machine learning-based model for the prediction of the risk of developing T2DKD was built, and its effectiveness was verified. The CatBoost model can contribute to the diagnosis of T2DKD. Clinicians could gain more insights into the outcomes if the ML model is made interpretable.
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Affiliation(s)
- Xiao zhu Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Minjie Duan
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Hao dong Huang
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Yang Zhang
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Tian yu Xiang
- Information Center, The University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Wu ceng Niu
- Department of Nuclear Medicine, Handan First Hospital, Hebei, China
| | - Bei Zhou
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao lin Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Ting ting Zhang
- Department of Endocrinology, Fifth Medical Center of Chinese People's Liberation Army (PLA) Hospital, Beijing, China
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Liu P, Tang L, Fang J, Chen C, Liu X. Association between recovery/occurrence of metabolic syndrome and rapid estimated glomerular filtration rate decline in middle-aged and older populations: evidence from the China Health and Retirement Longitudinal Study. BMJ Open 2022; 12:e059504. [PMID: 36261237 PMCID: PMC9582318 DOI: 10.1136/bmjopen-2021-059504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Few studies have explored correlations between metabolic syndrome (MetS) alterations and renal deterioration in longitudinal cohorts. We aim to investigate associations between MetS recovery/development and rapid estimated glomerular filtration rate (eGFR) decline in the China Health and Retirement Longitudinal Study (CHARLS). DESIGN Longitudinal cohort study. SETTING This study is a secondary analysis of CHARLS. PARTICIPANTS After excluding individuals with age <45 years old, eGFR <60 mL/min/1.73 m2 and clinician-reported malignant tumour, heart disease, stroke or kidney disease at baseline, 4142 participants with complete data were selected from the CHARLS during the 4-year follow-up period (2011-2015). OUTCOME MEASURES MetS were measured at 2011 and 2015 in CHARLS. A rapid eGFR decline was defined as an average annual eGFR decline of >3 mL/min/1.73 m2. The associations between rapid eGFR decline and MetS recovery/development were analysed using multivariable adjusted logistic models. RESULTS According to MetS baseline status and follow-up, participants were divided into four groups: (1) 2460 (59.4%) in the MetS-free group, (2) 361 (8.7%) in the MetS-developed group, (3) 499 (12.0%) in the MetS recovery group and (4) 822 (19.8%) in the MetS chronic group. When compared with the MetS chronic group, the multivariable adjusted OR of rapid eGFR decline in the MetS recovery group was 0.64 (OR: 0.64; 95% CI 0.45 to 0.90, p=0.01). In contrast, when compared with the MetS-free group, the multivariable adjusted OR of rapid eGFR decline in the MetS-developed group was 1.00 (OR: 1.00; 95% CI 0.73 to 1.38, p=0.98). CONCLUSIONS Over the 4-year follow-up period, we found that MetS recovery was associated with a reduced risk of rapid eGFR decline in middle-aged and older adults, while MetS occurrence was not related to rapid eGFR decline. Recovery from MetS appeared to protect against a rapid decline in eGFR.
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Affiliation(s)
- Peijia Liu
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Nephrology, Guangzhou Eighth People's Hospital,Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Leile Tang
- Department of Cardiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jia Fang
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chaojin Chen
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xun Liu
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of Obesity in Kidney Diseases. Nutrients 2021; 13:nu13124482. [PMID: 34960033 PMCID: PMC8703549 DOI: 10.3390/nu13124482] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
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Kim MS, Shin KA. Serum Uric Acid to Creatinine Ratio as a Predictor of Metabolic Syndrome in Healthy Adults Men. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2019. [DOI: 10.15324/kjcls.2019.51.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Myong Soo Kim
- Department of Laboratory Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyung A Shin
- Department of Clinical Laboratory Science, Shinsung University, Dangjin, Korea
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Alizadeh S, Ahmadi M, Ghorbani Nejad B, Djazayeri A, Shab-Bidar S. Metabolic syndrome and its components are associated with increased chronic kidney disease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies. Int J Clin Pract 2018; 72:e13201. [PMID: 29790628 DOI: 10.1111/ijcp.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & AIMS Observational studies examining the relationship between metabolic syndrome and the risk of chronic kidney disease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies. METHODS The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016 to identify all relevant studies. Risk estimates and their corresponding 95% confidence intervals (CIs) for the associations of MetS and its components with CKD risk were extracted and pooled using a random-effects model. RESULTS A total of 66 studies, including 18 prospective cohorts and 48 cross-sectional studies, with 699 065 CKD patients and 11 109 003 participants were included in the meta-analysis. When all definitions were pooled, the presence of MetS was associated with a significant 50% increase of CKD risk (OR = 1.50, 95% CI = 1.43-1.56), with evidence of moderate heterogeneity (I2 = 72.3%, P < .001). The risk of CKD associated with MetS was higher in studies using the American Heart Association/National Heart, Lung, and Blood Institute criteria (OR = 1.68, 95% CI = 1.25-2.10) compared with those using the Adult Treatment Panel III (OR = 1.49, 95% CI = 1.42-1.56) and the International Diabetes Federation (OR = 1.32, 95% CI = 1.22-1.41) definitions. This relationship was independent of diabetes status. Moreover, all individual components of the MetS were significantly associated with CKD, and their coexistence resulted in an escalating dose-response relationship. The sensitivity and subgroup analyses established the stability of the findings. CONCLUSIONS This meta-analysis strongly suggests that the metabolic syndrome and its components are independently associated with the increased risk of CKD.
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Affiliation(s)
- Shahab Alizadeh
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahsa Ahmadi
- Department of Microbiology, Faculty of Basic Sciences, Karaj Branch, Islamic Azad University, Alborz, Iran
| | - Behnam Ghorbani Nejad
- Department of pharmacology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abolghassem Djazayeri
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Relationship between Metabolic Syndrome and Uric Acid to Creatinine Ratio in Korean Adults: Korea National Health and Nutrition Examination Survey 2016. ACTA ACUST UNITED AC 2018. [DOI: 10.15384/kjhp.2018.18.3.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al-Daghri NM, Al-Attas OS, Wani K, Sabico S, Alokail MS. Serum Uric Acid to Creatinine Ratio and Risk of Metabolic Syndrome in Saudi Type 2 Diabetic Patients. Sci Rep 2017; 7:12104. [PMID: 28935934 PMCID: PMC5608718 DOI: 10.1038/s41598-017-12085-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/04/2017] [Indexed: 12/22/2022] Open
Abstract
This study aimed to investigate whether uric acid to creatinine (UA/Cr) ratio is associated with higher risk of metabolic syndrome (MetS) and its components. 332 adult Saudi type 2 diabetes mellitus (T2DM) patients were divided into UA/Cr tertiles. Risk for full MetS was significantly highest in individuals that constitutes the uppermost serum UA/Cr tertile [Odds ratio (OR): 1.80, 95% confidence interval (CI): 1.0–3.3; p < 0.001) after adjustment for age, gender and BMI. Similarly, risk for individual components of MetS like central obesity, hypertriglyceridemia, low HDL-cholesterol and hypertension was significantly highest in this tertile with OR’s of 2.61 (1.2–5.6), 1.42 (0.7–2.3), 1.45 (0.7–2.8) and 1.16 (0.6–2.2) respectively (all p-values < 0.001) after adjustment for age, gender, BMI and other components of MetS. Furthermore, serum UA/Cr levels increased with increasing number of MetS components (mean values of 4.44, 4.49, 4.64, 4.89 and 4.91 respectively for 1,2,3,4 and 5 MetS components, p-values < 0.001 after adjusting for age, gender and BMI). Our data suggest that serum UA/Cr in T2DM patients is strongly associated with full MetS as well as its individual components. These findings are of considerable clinical importance as serum UA/Cr may be used as a marker in the pathogenesis of MetS.
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Affiliation(s)
- Nasser M Al-Daghri
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia. .,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Omar S Al-Attas
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Kaiser Wani
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Shaun Sabico
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Majed S Alokail
- Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.,Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
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8
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Alswat KA, Althobaiti A, Alsaadi K, Alkhaldi AS, Alharthi MM, Abuharba WA, Alzaidi AA. Prevalence of Metabolic Syndrome Among the End-Stage Renal Disease Patients on Hemodialysis. J Clin Med Res 2017; 9:687-694. [PMID: 28725317 PMCID: PMC5505305 DOI: 10.14740/jocmr3064w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/06/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Patients with metabolic syndrome (MetS) have a 2.6-fold greater risk of incident chronic kidney disease (CKD). The primary goal of this study was to assess the prevalence of MetS in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) and the impact of MetS presence on HD-related outcomes. METHODS This is a cross-sectional study conducted in the Dialysis Center, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia. It was conducted among ESRD patients that attended the Dialysis Center between August 2013 and September 2016. We excluded patients on peritoneal dialysis and those < 18 years old. We used the International Diabetes Federation (IDF) criteria to identify patients with MetS. RESULTS A total of 241 patients with ESRD on HD were found, with a mean age of 48.8 (SD 16) years, mean body mass index (BMI) of 25.6 (SD 8.7) kg/m2, and mean waist circumference (WC) of 92.0 (SD 23.5) cm. The mean duration of the HD was 69.3 (SD 65.6) months with arteriovenous fistula (AVF) as the most common access for HD. Of the patients, 38.2% had MetS. Compared to those without MetS, those with MetS were more likely to be older (P < 0.001), be female (P < 0.001), be married (P < 0.001), have higher BMI (P < 0.001), have larger WC (P < 0.001), have T2D and hypertension (HTN) (P < 0.001), have shorter HD duration (P < 0.001), have a longer duration since the AVF was placed (P = 0.026), and have high post-HD creatinine levels (P = 0.010) and were less likely to have adequate HD (P = 0.004) and have parathyroid hormone (PTH) at goal (P = 0.046). CONCLUSION MetS is common among ESRD and MetS was associated with more comorbidity, worse anthropometric measures at baseline, and worse HD-related outcomes. The limitations were small sample size and single center.
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Affiliation(s)
| | - Awwadh Althobaiti
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khulod Alsaadi
- Department of Medicine, Taif University, Taif, Saudi Arabia
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Chen J, Kong X, Jia X, Li W, Wang Z, Cui M, Xu D. Association between metabolic syndrome and chronic kidney disease in a Chinese urban population. Clin Chim Acta 2017; 470:103-108. [PMID: 28501388 DOI: 10.1016/j.cca.2017.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/07/2017] [Accepted: 05/09/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few studies have examined the relationships between the prevalence of chronic kidney disease (CKD) and the metabolic risk factors in a developing country such as China, where genetic and environmental backgrounds differ from those in Western countries. METHODS The subjects of this cross-sectional study were the individuals from 18 to 92y. The metabolic syndrome (MetS) was defined based on the criteria of Adult Treatment Panel Third Report (ATP III), but using body mass index (BMI) instead of waist circumference. CKD was defined as decreased estimated glomerular filtration rate (eGFR<60mL/min/1.73m2) or presence of proteinuria (urine protein≥1+) assessed using dipstick method. RESULTS A total of 26,601 subjects (average age of 48.7y) were analyzed. Among them, the prevalence of the MetS and CKD was 36.4% and 3.0%, respectively. After adjustment for age, gender, cigarette smoking and alcohol drinking, the prevalence of CKD was significantly greater in subjects with than without MetS (OR 1.99, 95% CI 1.57-2.53, p<0.001). Multivariate-adjusted odd ratios for CKD in subjects with 3, 4 or 5 MetS components were 1.82 (95% CI 1.31-2.52, p<0.001), 2.92 (95% CI 2.09-4.09, p<0.001), and 3.07 (95% CI 1.67-5.67, p<0.001), respectively. After further adjustments were made for the other components of MetS, only high fasting glucose (OR 1.52, 95% CI 1.12-2.05) were significant risk factors for reduced renal function(eGFR<60mL/min/1.73m2). High blood pressure (OR 1.81, 95% CI 1,42-2.29), high triglycerides (OR 1.34, 95% CI 1.11-1.67) and high fasting glucose (OR 2.07, 95% CI 1.62-2.66) were significant risk factors for proteinuria. CONCLUSIONS MetS was highly prevalent in the middle-aged and elderly Chinese population in the city of Jinan. There was a graded relationship between the number of MetS components and risk of CKD. High fasting blood glucose levels were the main risk factor of reduced renal function. High blood pressure, high fasting blood glucose levels and high triglycerides were main risk factors for proteinuria.
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Affiliation(s)
- Juan Chen
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Xianglei Kong
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Xiaoyan Jia
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Wenbin Li
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Zunsong Wang
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Meiyu Cui
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China
| | - Dongmei Xu
- Department of Nephrology, Shandong Qianfoshan Hospital affiliated to Shandong University, No. 16766, Jingshi Road, Jinan 250014,China.
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10
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Wang J, Li X, Han X, Yang K, Liu B, Li Y, Peipei Wu, Xuezhen Liu, Kuai Yu, Xiayun Dai, Yuan J, Yao P, Zhang X, Huan Guo, Youjie Wang, Weihong Chen, Sheng Wei, Miao X, Xinwen Min, Liang Y, Handong Yang, Hu FB, Tangchun Wu, He M. Serum creatinine levels and risk of metabolic syndrome in a middle-aged and older Chinese population. Clin Chim Acta 2014; 440:177-82. [PMID: 25476134 DOI: 10.1016/j.cca.2014.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/05/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The prevalence of metabolic syndrome (MetS) persistently increased. Several studies have found serum creatinine (SCr) concentrations related to cardiovascular disease and type 2 diabetes. The relationship between SCr concentrations and MetS is unknown. METHODS We measured SCr concentrations and MetS in 22363 individuals (10,151 males, 12,212 females) from the Dongfeng-Tongji Cohort in Shiyan, China from 2008 to 2009. RESULTS The prevalence of MetS was 30.6% in the study population. In the multivariable-adjusted logistic regression analyses, higher SCr concentrations were associated with a higher risk of MetS (P trend<0.0001). Compared with the lowest extreme quintiles, subjects with the highest quintiles had 1.34 fold risk of MetS (95% confidence interval (CI): 1.22-1.47). The SCr concentrations were also associated with the individual component of MetS. In addition, higher SCr concentrations were associated with higher risk of MetS with more components. CONCLUSIONS There is a graded positive association between the SCr concentrations and MetS risk in a middle aged and older Chinese population. Higher SCr concentrations, even within normal ranges, were associated with higher risk of MetS. The SCr might be a useful indicator of MetS and its related diseases.
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Affiliation(s)
- Jing Wang
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xiulou Li
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Xu Han
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Yang
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Bing Liu
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Yaru Li
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Peipei Wu
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xuezhen Liu
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Kuai Yu
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xiayun Dai
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Yao
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaomin Zhang
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Guo
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Youjie Wang
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Weihong Chen
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wei
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Miao
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Xinwen Min
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Yuan Liang
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Handong Yang
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Frank B Hu
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Tangchun Wu
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Meian He
- Institute of Occupational Medicine and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China.
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Nashar K, Egan BM. Relationship between chronic kidney disease and metabolic syndrome: current perspectives. Diabetes Metab Syndr Obes 2014; 7:421-35. [PMID: 25258547 PMCID: PMC4173754 DOI: 10.2147/dmso.s45183] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Both metabolic syndrome (MetS) and chronic kidney disease (CKD) are increasing in incidence and lead to significant cardiovascular morbidity and mortality. The relationship between these two entities is complex. Individual components of the MetS are known risk factors for incident kidney disease, but it is not clear how the clustering of these components is linked to the development and progression of kidney disease. Cross-sectional studies show an association of the MetS and prevalent CKD; however, one cannot draw conclusions as to which came first - the MetS or the kidney disease. Observational studies suggest a relationship between MetS and incident CKD, but they also demonstrate the development of MetS in patients with established CKD. These observations suggest a bidirectional relationship. A better understanding of the relationship between components of the MetS and whether and how these components contribute to progression of CKD and incident cardiovascular disease could inform more effective prevention strategies.
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Affiliation(s)
- Khaled Nashar
- Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Brent M Egan
- Care Coordination Institute and Greenville Health System, Greenville, SC, USA
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12
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Mendy VL, Azevedo MJ, Sarpong DF, Rosas SE, Ekundayo OT, Sung JH, Bhuiyan AR, Jenkins BC, Addison C. The association between individual and combined components of metabolic syndrome and chronic kidney disease among African Americans: the Jackson Heart Study. PLoS One 2014; 9:e101610. [PMID: 24991817 PMCID: PMC4081650 DOI: 10.1371/journal.pone.0101610] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/09/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Approximately 26.3 million people in the United States have chronic kidney disease and many more are at risk of developing the condition. The association between specific metabolic syndrome components and chronic kidney disease in African American individuals is uncertain. Methods Baseline data from 4,933 participants of the Jackson Heart Study were analyzed. Logistic regression models were used to estimate the odds and 95% confidence intervals of chronic kidney disease associated with individual components, metabolic syndrome, the number of components, and specific combinations of metabolic syndrome components. Results Metabolic syndrome was common with a prevalence of 42.0%. Chronic kidney disease was present in 19.4% of participants. The prevalence of metabolic components was high: elevated blood pressure (71.8%), abdominal obesity (65.8%), low fasting high density lipoprotein cholesterol (37.3%), elevated fasting glucose (32.2%) and elevated triglycerides (16.2%). Elevated blood pressure, triglycerides, fasting blood glucose, and abdominal obesity were significantly associated with increased odds of chronic kidney disease. Participants with metabolic syndrome had a 2.22-fold (adjusted odds ratio (AOR) 2.22; 95% CI, 1.78–2.78) increase in the odds of chronic kidney disease compared to participants without metabolic syndrome. The combination of elevated fasting glucose, elevated triglycerides, and abdominal obesity was associated with the highest odds for chronic kidney disease (AOR 25.11; 95% CI, 6.94–90.90). Conclusion Metabolic syndrome as well as individual or combinations of metabolic syndrome components are independently associated with chronic kidney disease in African American adults.
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MESH Headings
- Adult
- Black or African American
- Blood Glucose/metabolism
- Blood Pressure
- Cholesterol, HDL/blood
- Female
- Humans
- Male
- Metabolic Syndrome/blood
- Metabolic Syndrome/complications
- Metabolic Syndrome/epidemiology
- Metabolic Syndrome/physiopathology
- Middle Aged
- Mississippi
- Models, Biological
- Obesity, Abdominal/blood
- Obesity, Abdominal/complications
- Obesity, Abdominal/epidemiology
- Obesity, Abdominal/physiopathology
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/epidemiology
- Renal Insufficiency, Chronic/physiopathology
- Triglycerides/blood
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Affiliation(s)
- Vincent L. Mendy
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
- * E-mail:
| | - Mario J. Azevedo
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
| | - Daniel F. Sarpong
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
- RTRN Data Coordinating Center, Jackson State University, Jackson, Mississippi, United States of America
| | - Sylvia E. Rosas
- Joslin Diabetes Center, Kidney and Hypertension Section, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Olugbemiga T. Ekundayo
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
| | - Jung Hye Sung
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
| | - Azad R. Bhuiyan
- Department of Epidemiology and Biostatistics, School of Health Sciences, College of Public Service, Jackson State University, Jackson, Mississippi, United States of America
| | - Brenda C. Jenkins
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, United States of America
| | - Clifton Addison
- Jackson Heart Study, Jackson State University, Jackson, Mississippi, United States of America
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Li Y, Chen Y, Liu X, Liang Y, Shao X, Zhang Y, Wang H, Wang X, Li B, Deng K, Liu Q, Holthöfer H, Liu H, Zou H. Metabolic syndrome and chronic kidney disease in a Southern Chinese population. Nephrology (Carlton) 2014; 19:325-31. [PMID: 24548104 DOI: 10.1111/nep.12219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Yongqiang Li
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Youming Chen
- Clinical Laboratory; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xinyu Liu
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Yan Liang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xiaofei Shao
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Ying Zhang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Honglei Wang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Xiaohong Wang
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Bin Li
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Kangping Deng
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Qin Liu
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Harry Holthöfer
- National Centre for Sensor Research/BioAnalytical Sciences; Dublin City University; Dublin Ireland
| | - Hongmei Liu
- Department of Ultrasound; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
| | - Hequn Zou
- Department of Nephronology; Institute of Nephronology and Urology; The Third Affiliated Hospital of Southern Medical University; Guangzhou China
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Kang YU, Kim HY, Choi JS, Kim CS, Bae EH, Ma SK, Kim SW. Metabolic syndrome and chronic kidney disease in an adult Korean population: results from the Korean National Health Screening. PLoS One 2014; 9:e93795. [PMID: 24807226 PMCID: PMC4013132 DOI: 10.1371/journal.pone.0093795] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/07/2014] [Indexed: 02/06/2023] Open
Abstract
Background This study was aimed to examine the prevalence of metabolic syndrome (MS) and chronic kidney disease (CKD), and the association between MS and its components with CKD in Korea. Methods We excluded diabetes to appreciate the real impact of MS and performed a cross-sectional study using the general health screening data of 10,253,085 (48.86±13.83 years, men 56.18%) participants (age, ≥20 years) from the Korean National Health Screening 2011. CKD was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Results The prevalence of CKD was 6.15% (men, 5.37%; women, 7.15%). Further, 22.25% study population had MS (abdominal obesity, 27.98%; hypertriglyceridemia, 30.09%; low high-density cholesterol levels, 19.74%; high blood pressure, 43.45%; and high fasting glucose levels, 30.44%). Multivariate-adjusted analysis indicated that proteinuria risk increased in participants with MS (odds ratio [OR] 1.884, 95% confidence interval [CI] 1.867–1.902, P<0.001). The presence of MS was associated with eGFR<60 mL/min/1.73 m2 (OR 1.364, 95% CI 1.355–1.373, P<0.001). MS individual components were also associated with an increased CKD risk. The strength of association between MS and the development of CKD increase as the number of components increased from 1 to 5. In sub-analysis by men and women, MS and its each components were a significant determinant for CKD. Conclusions MS and its individual components can predict the risk of prevalent CKD for men and women.
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Affiliation(s)
- Yong Un Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ha Yeon Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Joon Seok Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- * E-mail:
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15
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Ming J, Xu S, Yang C, Gao B, Wan Y, Xing Y, Zhang L, Yang W, Ji Q. Metabolic syndrome and chronic kidney disease in general Chinese adults: Results from the 2007–08 China National Diabetes and Metabolic Disorders Study. Clin Chim Acta 2014; 430:115-20. [PMID: 24412317 DOI: 10.1016/j.cca.2014.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 12/31/2022]
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Carbone F, Montecucco F, Mach F, Pontremoli R, Viazzi F. The liver and the kidney: two critical organs influencing the atherothrombotic risk in metabolic syndrome. Thromb Haemost 2013; 110:940-58. [PMID: 23966104 DOI: 10.1160/th13-06-0499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/12/2013] [Indexed: 02/07/2023]
Abstract
The increased atherothrombotic risk in patients with metabolic syndrome (MetS) has been classically explained by the multiplicative effect of systemic concomitant pro-atherosclerotic factors. In particular, centripetal obesity, dyslipidaemia, glucose intolerance, hypertension (differently combined in the diagnosis of the disease) would be expected to act as classical cardiovascular risk conditions underlying accelerated atherogenesis. In order to better understand specific atherosclerotic pathophysiology in MetS, emerging evidence focused on the alterations in different organs that could serve as both pathophysiological targets and active players in the disease. Abnormalities in adipose tissue, heart and arteries have been widely investigated in a variety of basic research and clinical studies in MetS. In this narrative review, we focus on pathophysiological activities of the liver and kidney. Considering its key role in metabolism and production of soluble inflammatory mediators (such as C-reactive protein [CRP]), the liver in MetS has been shown to be altered both in its structure and function. In particular, a relevant amount of the fat accumulated within this organ has been shown to be associated with different degrees of inflammation and potential insulin resistance. In humans, non-alcoholic fatty liver disease (NAFLD) has been described as the hepatic manifestation of MetS. In an analogous manner, epidemiological evidence strongly suggested a "guilty" association between MetS and chronic kidney disease (CKD). Some biomarkers of hepatic (such as C-reactive protein, TNF-alpha or other cytokines) and renal diseases (such as uric acid) associated with MetS might be particularly useful to better manage and prevent the atherothrombotic risk.
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Affiliation(s)
- F Carbone
- Dr. Fabrizio Montecucco, MD, PhD, Cardiology Division, Foundation for Medical Researches, Department of Internal Medicine, University of Geneva, 64 Avenue Roseraie, 1211 Geneva, Switzerland, Tel: +41 22 382 72 38, Fax: +41 22 382 72 45, E-mail:
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Gluba A, Mikhailidis DP, Lip GY, Hannam S, Rysz J, Banach M. Metabolic syndrome and renal disease. Int J Cardiol 2013; 164:141-50. [DOI: 10.1016/j.ijcard.2012.01.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 10/31/2011] [Accepted: 01/06/2012] [Indexed: 02/07/2023]
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18
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Hamad AA, Khalil AA, Connolly V, Ahmed MH. Relationship between non-alcoholic fatty liver disease and kidney function: A communication between two organs that needs further exploration. Arab J Gastroenterol 2012; 13:161-5. [DOI: 10.1016/j.ajg.2012.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/19/2012] [Accepted: 06/21/2012] [Indexed: 01/22/2023]
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Guo J, Meng F, Ma N, Li C, Ding Z, Wang H, Hou R, Qin Y. Meta-analysis of safety of the coadministration of statin with fenofibrate in patients with combined hyperlipidemia. Am J Cardiol 2012; 110:1296-301. [PMID: 22840347 DOI: 10.1016/j.amjcard.2012.06.050] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 01/17/2023]
Abstract
Addition of fenofibrate to statin therapy might represent a viable treatment option for patients whose high risk for coronary heart disease is not controlled by a statin alone. However, safety of coadministration of statin with fenofibrate has been a great concern. The present study tested the safety of coadministration of statin with fenofibrate. We systematically searched the literature to identify randomized controlled trials examining safety of coadministration of statin with fenofibrate. A meta-analysis was performed to estimate safety of coadministration of statin with fenofibrate using fixed-effects models. There were 1,628 subjects in the identified 6 studies. Discontinuation attributed to any adverse events (4.5% vs 3.1%, p = 0.20), any adverse events (42% vs 41%, p = 0.82), adverse events related to study drug (10.9% vs 11.0%, p = 0.95), and serious adverse events (2.0% vs 1.5%, p = 0.71) were not significantly different in the 2 arms. Incidence of alanine aminotransferase and/or aspartate aminotransferase ≥3 times upper limit of normal in the combination therapy arm was significantly higher than in the statin monotherapy arm (3.1% vs 0.2%, p = 0.0009). In the 6 trials with 1,628 subjects no case of myopathy or rhabdomyolysis was reported. In conclusion, statin-fenofibrate combination therapy was tolerated as well as statin monotherapy. Physicians should consider statin-fenofibrate combination therapy to treat patients with mixed dyslipidemia.
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Jiang L, Liang Y, Qiu B, Wang F, Duan X, Yang X, Yang J, Huang W, Wang N. Metabolic syndrome and chronic kidney disease in a rural Chinese population. Clin Chim Acta 2011; 412:1983-8. [DOI: 10.1016/j.cca.2011.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/08/2011] [Accepted: 07/16/2011] [Indexed: 11/26/2022]
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Metabolic syndrome in chronic kidney disease and renal transplant patients in North India. Int Urol Nephrol 2011; 44:937-43. [PMID: 21660424 DOI: 10.1007/s11255-011-9998-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
AIM The cluster of biochemical and clinical abnormalities known as metabolic syndrome (MS) has become a public health problem even in developing countries. Previous studies have shown a graded relationship between MS components and worsening renal function in the general population. The prevalence of MS in non-dialysis-dependent CKD (NDD-CKD) and kidney transplant recipients in the North Indian population is unknown. METHODS We studied all patients with stable CKD and with renal transplantation attending the nephrology clinic in a large centre in North India over an eight-week period. All transplant patients had stable graft function for 3 months prior to recruitment. MS was defined according to the International Diabetes Federation (IDF) 2007 guidelines. A total of 252 (155 NDD-CKD and 97 renal transplant recipients) patients were studied. RESULTS MS was present in 86 (34%) patients. The prevalence of MS was similar in NDD-CKD and transplant patients [60 (39%) vs. 26 (27%), P = 0.052]. Patients with MS were older than those without MS (48 ± 12 years-old vs. 40 ± 14 years-old, P < 0.001) and MS was more common in women than in men (59% vs. 26%, P < 0.001). Female gender was an independent risk factor for MS in this population [adjusted OR 5.25 (95% CI: 2.74-10.06)]. With advancing CKD, the prevalence of MS decreased in the NDD-CKD patients. Impaired glucose tolerance and hypertriglyceridemia were independent predictors of MS. Hypertension was not a predictor of MS in NDD-CKD. In transplant recipients, hypertriglyceridemia, hypertension and low HDL cholesterol predicted the risk for MS. CONCLUSION MS is common in CKD and renal transplant patients in North India. The risk of MS decreases with declining eGFR in CKD patients. Female gender and hypertriglyceridemia independently predict the risk of MS in both NDD-CKD and transplant recipients.
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Hwang SJ, Tsai JC, Chen HC. Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology (Carlton) 2010; 15 Suppl 2:3-9. [PMID: 20586940 DOI: 10.1111/j.1440-1797.2010.01304.x] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chronic kidney disease (CKD) has emerged as a global public health burden. Taiwan has the highest incidence and prevalence rates of end-stage renal disease (ESRD) in the world. In this review, the following key issues of CKD in Taiwan are addressed: epidemiological data, underlying diseases patterns, risk factors, public health concerns and a preventive project. Prevalence of CKD are reported to be 6.9% for CKD stage 3-5, 9.83% for clinically recognized CKD and 11.9% for CKD stage 1-5. However, overall awareness of CKD is low, 9.7% for CKD stage 1-3 and 3.5% for stage 1-5. Diabetes mellitus (43.2%), chronic glomerulonephritis (25.1%), hypertension (8.3%) and chronic interstitial nephritis (2.8%) are four major underlying renal diseases of ESRD. Older age, diabetes, hypertension, smoking, obesity, regular use of herbal medicine, family members (both relatives and spouses), chronic lead exposure and hepatitis C are associated with higher risk for CKD. Impact of CKD increases risk of all-cause mortality and cardiovascular diseases, especially in those with overt proteinuria and advanced CKD stages. These impacts lead to increased medical costs. The nationwide CKD Preventive Project with multidisciplinary care program has proved its effectiveness in decreasing dialysis incidence, mortality and medical costs. It is crucially significant from Taiwan experience on CKD survey and preliminary outcome of the preventive project. Provision of a more comprehensive public health strategy and better care plan for CKD should be achieved by future international collaborative efforts and research.
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Affiliation(s)
- Shang-Jyh Hwang
- Department of Medicine, Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, College of Medicine, Kaohsiung, Taiwan
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